by Courtney U. Graham
I became aware of fibromyalgia several years ago while studying herbalism in California. My teacher, a few years older than me and with wisdom beyond her stature and age, spoke openly about having “a disability.” I came to understand her “dis-ease” to be fibromyalgia. Regarding living with this disease, she says, “There are things we may desire to experience that are out of reach. This is one reason I consider it a disability rather than a dis-ease.” She feels like her pain is misunderstood by family and friends, so her inability to participate in life is often viewed as being “needy” or “overly sensitive” (Merriman, 2022.) It has been a debilitating experience living with fibromyalgia, leading her to explore an alternative lifestyle that involves living in close connection to the outdoors, eating healthy food, and practicing various modalities of meticulous self-care.
Although modern science can observe and describe the symptoms of fibromyalgia, the exact cause of the disease is unknown (Wilcox, 2021). And the prognosis? Incurable. In hopes of better understanding our client’s experience and being a trusted support, we can educate ourselves about the nature of their physical experience. A “fibro patient,” as they are apt to be called, experiences widespread pain as a tell-tale symptom (Werner, 2019.) Potentially debilitating, the pain appears in the soft tissues—muscles, tendons, ligaments, etc.—presenting in patterns of “tender points” (Archer and Nelson, 2021). These points appear in bilateral pairs around the neck, shoulders, hips, and low back (see chart below). Along with this defining feature of the disease, other symptoms that accompany fibromyalgia are sometimes mistaken for lupus or Lyme disease (Werner, 2019). These include insomnia, chronic fatigue, depression, indigestion, and migraines. Symptoms may come and go with “flare ups” of pain, often depending on the presence of external stressors. Thus the importance of stress management appears to be key in helping to manage the patient’s recurrence of pain and other symptoms.
I find it interesting that the human body can experience such debilitating discomfort without a clear underlying cause revealed through modern science. What we can explain through western medicine is that this disease affects the central nervous system, resulting in harmless stimuli being experienced as pain (Werner, 2019). One theory suggests that fibro patients have high numbers of pain receptors in their fascia; therefor any restriction or tension within their fascia creates a sensation that pain is originating from the muscles and joints (Archer and Nelson, 2021). Also noted within this disease is a dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis, which increases the release of stress hormones—a factor also observed in chronic fatigue and depressive disorders (Werner, 2019). This abundance of stress hormones, accompanied by the pain of tender points, reveals why fibro patients would benefit from a massage with gentler strokes and a softer, relaxation-focused touch.
The fibromyalgia body requests awareness and attention—or demands it—with symptoms so severe as to reshape one’s entire lifestyle. Those who learn to live with fibromyalgia must adapt their career and family choices to cope with their body’s needs (Merriman, 2022). For example, standing for long periods at a job becomes unsustainable, and taking care of children during a “flare-up” may be nearly impossible. Thus, protocols for preventing the recurrence of symptoms becomes a requirement to live a functional life. Methods that provide relief from discomfort are not a luxury, but a necessity, to a fibro patient. This is where massage therapists can prove to be lifesavers.
Massage therapy applications for a fibro patient are shown to provide pain relief, improve sleep quality, boost mood, and reduce anxiety (Werner, 2019). My herbalism teacher who lives with the chronic pain of fibromyalgia reports that receiving bodywork taught her how to be fully present in her body in an enjoyable way, moment to moment, throughout each session (Merriman, 2022). She says, “Receiving quality care from [bodyworkers] has role-modeled for me how to be gentle, respectful, and attentive to my body– something that was not taught to me growing up.” As massage therapists, we can provide healing simply through our mindful presence. Being attentive to our client is a way of modeling for them how to be more caring toward themselves. Being in conversation with our client throughout the treatment can give them a sense of being deeply cared for, listened to, and acknowledged—an experience they may not receive from friends, family, or other healthcare professionals.
Research has yet to reveal how massage may lessen the recurrence of flare-ups in fibromyalgia patients. However, anecdotal evidence shows us that clients with chronic symptoms of fibromyalgia who regularly receive massage find deep relief during and after being “on the table” (Arnold, 2022). To learn more, I interviewed a bodyworker who has been in the profession for nearly 20 years. She reports that often her clients with chronic pain—specifically fibromyalgia—claim that the only time they feel full relief is during or after a massage from her. Although raving reviews such as this may bolster a massage therapist’s confidence, she cautions against developing a co-dependent relationship with clients who have this view. Instead, it is important to empower the client. As massage therapists, we can encourage our clients to practice self-care at home, suggesting some stretches or other daily routines that may support their pain relief. We are careful not to “subscribe” protocols to our clients, but we can certainly share knowledge within our scope of practice, and model good self-care through our own routines.
As skilled bodyworkers, we want to help all our clients be as comfortable as possible; but when a specific client has particularly sensitive needs, this is an opportunity for us to take extra care in providing accommodations. A clean environment, plenty of blankets, pillows and bolster accommodations, a table warmer, clear consent, ongoing communication, and nourishing options for grounding after a session such as warm tea or snacks are just a few ideas for going above and beyond to provide a comfortable, healing space for our services.
Although fibromyalgia is deemed incurable, as massage therapists we can help bring comfort to our clients who not only endure the physical symptoms but also the social stresses of their ailment. Our mindful presence allows our client to feel cared for, and our skilled expertise, open communication, and thoughtful accommodations can serve to enhance all the known benefits of massage so our client may receive an optimal sense of wellbeing through our service. It is worth noting how these clients remind us of the importance of mindful self-care, and the power of slowing down and taking time to listen to ourselves and one another. They can reveal to us gentler ways of being in the world.
- Werner, Ruth. “Fibromyalgia.” A Massage Therapist’s Guide to Pathology: Critical Thinking and Practical Application, Books of Discovery, Boulder, CO, 2019.
- Merriman, Erin Rivera. Interview. Conducted by Courtney Graham. 2 Dec 2022.
- Wilcox, Claire. “What Is Fibromyalgia, and How Is It Treated? – Goodrx.” Good Rx Health, 1 Dec. 2021, https://www.goodrx.com/conditions/fibromyalgia/what-is.
- Archer, P., & Nelson, L. (2021). Applied Anatomy & Physiology for Manual Therapists (2nd ed., p. 233). Books of Discovery.
- Arnold, Carrie Lou. Interview. Conducted by Courtney Graham. 30 Nov 2022.